Normal liver

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Normal liver
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Fatty Liver
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Fatty Liver
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alcoholism. Diabetes mellitus, obesity, and
severe gastrointestinal malabsorption
Fatty Liver
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• Cirrhosis is a diffuse
  process characterized by fibrosis and the
  conversion of the normal liver architecture
  in to structurally abnormal nodules.
• Cell death,
• Progressive fibrosis,
• Regeneration

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CLASSIFICATION MORPHOLOGICAL
MICRONODULAR --- lt 3 mms.,
MACRONODULAR --- gt 3 mms., MIXED
AETIOLOGICAL A. Established etiological
associations 1. Alcoholism --- 60 - 70
2. Viral hepatitis (B, C D) 10 - 20
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3. Metabolic diseases, Haemochromatosis
--- 5 Wilson's disease,
Alpha-1-antitrypsin deficiency, Glycogen
storage diseases - III IV, Cystic
fibrosis, Galactosemia, Hereditary
fructose intolerance, Amino acid
disorders, Abetalipoproteinaemia,
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4. Biliary --- 5 - 10 Primary,
Secondary,
5. Venous outflow obstruction, Budd -
chiari syndrome, Veno - occlusive
disease, 6. Drugs toxins, 7. Intestinal
bypass for obesity, 8. Others
Sarcoidosis, Carcinomatous fibrosis,
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PATHOGENESIS OF FIBROSIS
Chronic Inflammation TNF - alpha, TGF -
beta, Interleukin - 1
TOXINS
Ito cell
Hepatic stellate cell
Disruption of extracellular Matrix
FIBROSIS
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• CLINICAL FEATURES
• Asymptomatic,
• Anorexia,
• Weight loss,
• Weakness --- debilitation,
• Palmar erythema ,
• Spiderangiomas,
• Gynecomastia,
• Gonadal atrophy,
• Amenorrhea,
• Bleeding tendencies

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Macronodular cirrhosis.
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Macronodular cirrhosis.
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Macronodular cirrhosis.
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Micronodular cirrhosis
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Micronodular Cirrhosis with Fatty Liver
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Micronodular Cirrhosis with Fatty Liver
Alcoholism, Wilson's disease, primary biliary
cirrhosis, hemochromatosis.
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Regenerative nodules are surrounded by fibrous
connective tissue
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Regenerative nodules Fatty Change
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Mallory's hyaline, also known as "alcoholic"
hyaline
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caput medusae
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Portal hypertension Pathogenesis in
cirrhosis Increased resistance in
sinusoids, Compression of central
veins, Anastomoses of arterial and portal
vessels

• Clinical consequences
• Ascites,
• Porto systemic venous shunts,
• Congestive splenomegaly,
• Hepatic encephalopathy,

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esophageal varices
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portal hypertension with splenomegaly
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Hemosiderosis/ pigment cirrhosis
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Prussian blue iron stain demonstrates the blue
granules of hemosiderin in hepatocytes and
Kupffer cells.
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PROGNOSIS DEATH PROGRESSIVE LIVER
FAILURE, PORTAL HYPERTENSION
BLEEDING EPISODES
( esophageal varices )
HEPATOCELLULAR CARCINOMA
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NORMAL
Exposure
Exposure
Abstinence
Abstinence
STEATOSIS
HEPATITIS
Abstinence
Severe exposure
Continued Exposure
Repeated attacks
CIRRHOSIS
ALCOHOLIC LIVER DISEASE
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TUMOURS OF THE LIVER
BENIGN --Adenomas,
MALIGNANT ( Primary ) --
Hepatoblastoma, -- Angiosarcoma,
-- Hepatocellular carcinoma, --
Cholangiocarcinoma
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LIVER CELL ADENOMAS

• Young women using oral contraceptives,
• Regress after discontinuance,
• Can be mistaken for hepatocellular ca.,
• Have tendency to rupture
• Severe intraperitoneal hemorrhage,
• Rarely may harbor hepatocellular ca.

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Hepatic adenoma
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Hepatic adenoma
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HAEMANGIOMA, LIVER
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Angiosarcoma

• Exposure to ---
• Vinyl chloride,
• Arsenic,
• Thorotrast
• Metastasise widely,
• Kills within a year.

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PRIMARY CARCINOMAS OF THE LIVER

• Hepatocellular carcinoma,
• ( Hepatoma, Hepatocyte origin ),
• Cholangiocarcinoma
• ( Origin Bile duct epithelium )

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Hepatocellular carcinoma Epidemiology

• Low incidence areas
• 2 - 4 cases/ yr. / 100,000 popn.,
• - North south America, Europe,
• High incidence areas
• 150 / yr. / 100,000 popn.,
• - Korea, Taiwan, Mozambique,
• Southeast China

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Hepatocellular carcinoma Epidemiology

• Blacks predominate,
• M F 8 1 in high incidence areas,

• High incidence areas
• Global incidence linked to HBV infection,
• High carrier state --- 200 fold risk,
• Cirrhosis may be absent,
• Seen around 20 40 years of age,

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Hepatocellular carcinoma Pathogenesis

• Molecular origins -- unclear,
• Cell turn-over ( cirrhosis, HBV, HCV )
• Mutations
• Viral integration ( HBV )

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HBV infection
Mutant Hepatic enzymes
Aflatoxin exposure
HEPATOCYTE
HEPATOCELLULAR CARCINOMA
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Hepatocellular carcinoma

• NO HBV INFECTION(Low incidence)
• HCV infection,
• Chronic alcoholism
• Haemochromatosis
• Hereditary Tyrosenemia
• ( 40 )

CIRRHOSIS
HEPATOCELLULAR CARCINOMA
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Morphology

• Macroscopic-
• Unifocal
• Multifocal
• Diffusely infiltrative

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Hepatocellular carcinomaClinical features

• Often marked by background cirrhosis and
  chronic hepatitis,
• Upper abdominal pain,
• Malaise, fatigue, weight loss, mass,
• Jaundice, fever, bleeding /-

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Hepatocellular carcinomaLaboratory findings

• Alpha fetoprotein -- 60 75 ,
• False positive
• Yolk-sac tumors,
• Cirrhosis,
• Massive liver necrosis,
• Normal pregnancy,
• Fetal distress
• Fetal defects -- spina bifida,
• Small lesions NOT detected

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Hepatocellular carcinoma
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Hepatocellular carcinoma
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Hepatocellular carcinoma
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Hepatocellular carcinoma
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Hepatocellular carcinoma
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HEPATOCELLULAR CARCINOMA- Trabecular pattern
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Metastases to the liver
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Metastases to the liver
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Hepatocellular carcinoma

• DEATH
• With in 10 months,
• Cachexia,
• G.I. Bleeding,
• Hepatic coma,
• Rupture of the tumor
• Hemorrhage

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Hepatocellular carcinoma

• FIBROLAMELLAR TYPE
• Affects young adults ( 20 40 yrs. ),
• No association with cirrhosis or HBV,
• Better prognosis
• --- 5 yr. Survival - 60

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Cholangiocarcinoma, liver
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CHOLANGIOCARCINOMA
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